Wise said he first learned about the problem last year when he received a call from Carol Weihrer of Reston, founder of an advocacy group called the Anesthesia Awareness Campaign. Six years ago, Weihrer says, she woke up in an operating room at Washington Hospital Center while doctors were removing her diseased eye.
"I don't think surgeons are tuned into it," Wise said. Unlike anesthesiologists or nurse anesthetists, surgeons typically see patients for postoperative appointments. A recent study found that recall of awareness is greater seven days after surgery than it is 24 hours afterward.
Jodie Stanley awoke from anesthesia during an operation on her right hand.
(Steve Gates - For The Washington Post)
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_____From The Post_____
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It Knows When You're Awake (The Washington Post, Nov 23, 2004)
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Robert Wise, M.D., vice president at the Joint Commission on Accreditation of Healthcare Organizations, was online to discuss patients who wake up during surgery.
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Knowledge of the problem has been hampered by the reluctance of patients to tell their doctors about it, said Peter S. Sebel, a professor of anesthesiology at Emory University in Atlanta. "Patients often don't report it because they're worried about being called crazy by their physicians," added Sebel, lead author of a study involving nearly 20,000 patients at seven teaching hospitals in the United States. Sebel's team estimated that about 100 patients wake up every workday in U.S. operating rooms for periods ranging from a few seconds to much longer.
The Quiet Storm
Anesthesiologists in particular have been loath to talk to patients about intraoperative awareness, which one recent study characterized as "second only to death as a 'dreaded' complication" among anesthesiologists.
Lawyer Douglas Hornsby of Newport News said he has represented a dozen patients who sued their anesthesiologists for malpractice after they developed PTSD from waking up during surgery. Two cases that went to trial in Virginia resulted in jury awards of $150,000 and $350,000, he said. But other cases, including one filed by Weihrer, were settled secretly, on the condition that the name of the doctor, the size of the payment and in some cases the entire court file be sealed. (Weihrer said her anesthesiologist paid her a substantial settlement.)
"That means no one ever hears about this problem," said Hornsby, who represented Weihrer.
Roger W. Litwiller, a Roanoke physician who is president of the American Society of Anesthesiologists (ASA), said that while his group is "very concerned" about intraoperative awareness, he thinks the problem has been "sensationalized" and considers the number of cases JCAHO cites to be inflated.
"These people are not specialists in anesthesiology," Litwiller said of JCAHO, adding that anesthesiologists know best how to handle the problem.
In 33 years of practice, he said, he's never learned he had a patient who was awake, nor have most of his colleagues. Litwiller said he worries that some of JCAHO's recommendations, such as holding preoperative discussions about the possibility of awareness with high-risk patients, could scare them into not having surgery.
"Of course," Litwiller added, "any patient who had an unpleasant experience in the operating room deserves all our compassion."
To JCAHO's Wise, professional denial stems from a "disconnect between patients and anesthesiologists," who typically meet their patients minutes before they are wheeled into the operating room and rarely talk to them afterward.
